When do Pennsylvania hospitals turn to crisis standards of care? And what does that mean to patients
Pennsylvania hospitals could soon move to a crisis standard of care and begin to turn away some patients as medical centers fill up and health care workers call out sick.
On Monday, 36 of the state's 240 hospitals reported a critical staff shortage, according to the U.S. Department of Health and Human Services. A critical staff shortage was anticipated next week at 47 medical centers in the state.
On Tuesday, hospitals in Delaware moved to an unprecedented crisis standard of care.
Emergency room diversions were reported in Columbus, San Antonio, and in northern New Jersey. Patients in ambulances were not sent to the closest hospitals.
On Friday, the emergency room at Springfield Hospital in Delaware County will close because of staffing issues.
Some hospitals in northeastern Pennsylvania already had temporary emergency room diversions in early January, said Robert Shipp, vice president of the Hospital & Healthsystem Association of Pennsylvania.
"The numbers are shocking," Shipp said of the patient numbers.
ATC Healthcare, a national provider of healthcare services with offices in Philadelphia, has provided temporary staffing for medical centers since 1982. “We’re seeing hospitals where 50% of staff are coming from temporary agencies,” said CEO David Savitsky.
“They are already in crisis,” Savitsky continued. “They’re lowering standards in order to continue to provide health care. You can have one wing of a hospital get sick all at the same time.”
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Smaller, rural hospitals could face their greatest challenge of the pandemic.
In Quakertown, St. Luke's Upper Bucks Campus had 54 available beds and 53 were occupied, according to HHS. All 10 beds in the intensive care unit were filled.
Wilkes-Barre General Hospital was at 96% capacity and the Regional Hospital of Scranton had 116 of 127 beds full, according to HHS.
"Omicron is so infectious that, despite the lower likelihood of serious illness for an individual, the risk is that so many people will catch it that the end result will be a lot of very sick people, including too many who will die of the disease," said Dr. Jeffrey Jahre, senior vice president of medical and academic affairs at St. Luke's Health Network.
Saint Vincent Hospital in Erie has moved to a “surge plan” due to the extreme numbers of patients.
“If there is a high percentage of COVID infections in the technical staff within imaging or in a physician specialty group, that could create a “crisis” scenario, that would move us to consider a decision to permit staff to return earlier than the traditional/contingency guidelines recommended by the CDC,” said Christopher Clark, hospital president.
“We would always continue to take all precautions to protect the safety of our patients and staff,” Clark continued.
Pennsylvania’s crisis standard of care plan is similar to the program now adopted in Delaware. Hospitals must notify the Pennsylvania Emergency Management Agency when moving to crisis status.
In the extreme scenario, health care workers make on-the-spot decisions and allocate resources to patients. The sick are assessed on their chances of survival.
In the crisis standard of care, nurses can be called upon to perform procedures typically reserved for doctors. Recovering patients could be placed in hallways, cafeterias and other "non-clinical areas."
Others could be discharged early from the hospital or turned away altogether based on their condition.
The plan was last updated in April 2020 by PEMA and the Hospital and Health System Association of Pennsylvania. At that time, officials warned about the ability to monitor such a crisis in medicine as it unfolds.
“There will be limited, or even inaccurate, information regarding the scale of a disaster,” the plan states. “Some patients needing care cannot be admitted to hospitals and instead will be sent home or to alternate care sites.”
Crisis standards of care have come under fire in recent years.
Some scientists have said the triage process disfavors patients of color, who are more likely to have conditions such as diabetes and hypertension. Such conditions could lower their score in a triage setting.
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St. Mary Medical Center in Bucks County has not moved into a crisis standard of care. But it has started a provider in triage (PTI) system from 10 a.m. to 6 p.m. weekdays.
Selected patients are moved to private exam rooms and reviewed by a physicians assistant who can perform medical procedures such as suture placement, abdominal pain diagnosis, migraine treatment, ankle sprain care, or order a CAT scan.
“Every hospital is dealing with this,” said Savitsy. “They might not be calling it a crisis level. But they’re dealing with a crisis. The beds are crowded. The emergency room is full. They do not want to alarm the public.”
David Bruce, Madolin Edwards, and Brian Myszkowski contributed to this story.
Contact reporter James McGinnis at jmcginnis@couriertimes.com
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This article originally appeared on Bucks County Courier Times: PA hospitals could move to crisis standard, emergency room diversions
